Compensation medical

Overview

To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values.

These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.

Has responsibility for performing a variety of duties requiring the regular use of independent judgement to manage and administer assigned Workers' Compensation Medical Only Claims.

Remains current on Workers' Compensation trends and impending or new legislation affecting the program. Provides assistance to staff members in support of other benefit programs.

EEO / AA / Disability / Veteran

Responsibilities

• 1. Performs review of new Workers' Compensation Medical Only claims in order to ensure compensability, proper documentation of injury, documentation of investigation(s), completeness of information and determine current medical status
• 3. Works directly with medical providers to gather medical information on a necessary basis to ensure the file is complete.

Authorize medical treatment or procedures and based on practiced protocols or within the YNHHS Medical Care Plan.

• 4. Establishes and implements most effective method and timing of ongoing follow up to bring cases to closure in order to limit the hospital's exposure
• 5. Regularly reviews files to identify potential recoveries from third parties. Takes appropriate action to initiate potential recoveries.
• 6. Monitors progress of all claims activity to ensure proper case management. Complete claim / case strategic summary
• 7. Review Workers' Compensation medical or expenses invoices. Authorize or deny medical / expense payments.
• 8. Establish financial reserves with documented rational. Review and adjust the reserves for the life of the claim and to reflect any changes in exposure
• 9. Regularly meets with Occupational Health and Wellness Services, departments, and Employee Relations to review claim.
• 10. Communicates effectively, verbally and in writing with internal and external parties on a variety of claim and account issues
• 11. Develops and forwards informational packets to employee, manager and / or physician once a claims file is initiated
• 12. Generally supports the efforts of the Compensation and Benefits Department to provide services, information and communication to the general employee population and the Hospital Management
• 13. Remains current on Workers' Compensation trends and impending or new legislation affecting the program.

Qualifications

EDUCATION

Bachelor's degree or equivalent work experience.

EXPERIENCE

One (1) to three (3) years of working within a Workers' Compensation environment and requiring working knowledge of Connecticut Workers' Compensation laws.

LICENSURE

Current Connecticut Licensed Workers Compensation Claims Adjustor required

SPECIAL SKILLS

Must be able to work independently with minimal supervision. Strong Microsoft Office skills especially, Excel. Excellent typing and data entry skills.

Ability to make arithmetic calculations and work frequently with figures . Good oral and written communication and interpersonal skills.

Knowledge of medical terminology. Proven critical thinking skills that demonstrate analysis / judgement and sound decision making with focus on attention to detail.

YNHHS Requisition ID

107439

Last updated : 2024-02-23